Parent and Provider Feedback Via Exit Interviews in a Pilot Randomized Controlled Trial, “Autism Eats”: A Qualitative Study

Children with Autism Spectrum Disorder (ASD) often exhibit feeding and eating behavior problems. The Autism Eats nutrition intervention was designed to improve problematic mealtime behaviors and diet quality in children with ASD under 3 years. To analyze qualitative data from exit interviews in a pilot randomized controlled trial (RCT). This study utilized preliminary data from semi-structured exit interviews conducted with early intervention (EI) providers and parents of toddlers with ASD. Participants were assigned to either the Autism Eats intervention or the Enhanced Usual Care (EUC) control group. Exit interviews were performed through virtual meetings post-intervention. Interviews took up to 50 minutes with questions on overall program, lesson structure/design, content/materials, delivery format, family involvement, intervention acceptability, and feeding and eating behavior changes. Interviews were recorded, transcribed verbatim, and analyzed for emerging themes and thematic codes using a general inductive approach. Constant comparisons were utilized until the codebook was finalized. Six major themes emerged: (1) Problems at mealtime, particularly not sitting at the table; (2) Sensory processing of food; (3) Communication at mealtime; (4) Improved diet quality (eg, “It would just teach you healthier habits for your child and learn more about your child's nutrition, too"); (5) Positive feedback on intervention materials (eg, "...the information is phenomenal, I think I can say that over and over again, and I love the handouts …"); and (6) Suggestions for program improvement (eg, more recipes). The majority of providers and parents in the Autism Eats group reported noticing an improvement in mealtime and eating behaviors, while the EUC participants did not particularly mention that the program helped with ASD-specific issues. Findings suggest that parents believe the Autism Eats intervention effectively addressed problematic mealtime behaviors and diet quality among children with ASD. Participants appreciated its focus on specific problematic behaviors and nutritional issues related to ASD. Intervention materials will be refined based on feedback and suggestions for a large-scale efficacy trial. NIH, The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)